Diabetes is a life-threatening health condition that affects millions of people around the world. Those of us who suffer from diabetes are either unable to produce insulin or cannot successfully process it. Insulin is a hormone that allows our cells to absorb glucose from the bloodstream and convert it to energy. A diagnosis of diabetes for yourself or a loved one can be scary, but it is possible to successfully manage the condition and lead a full life.
Diabetes is a complex issue affecting a person’s overall physical and mental health. Both type 1 and type 2 diabetes are chronic and have no known cure. The third type, gestational diabetes, is a rare complication of pregnancy that usually resolves on its own once the baby is born. The good news is that all forms of diabetes can be successfully managed with proper care.
Normally, sugars and starches in the carbohydrates we eat are converted into glucose by the enzyme amylase found in saliva and the small intestine. Once the food we eat is broken down, glucose enters the liver. The liver controls the release of glucose into the bloodstream. Special cells in the pancreas monitor blood glucose levels. When glucose levels rise, beta cells in the pancreas respond by secreting the hormone insulin. Insulin acts like a key unlocking the mechanism that allows glucose to enter the cells in our muscles and other tissues where it is either converted into energy for immediate use or into fat for long-term storage.
People with type 1 diabetes don’t produce enough insulin, while people with type 2 diabetes do produce insulin, but it doesn’t work as effectively as it should.
Today diabetes affects about 1 in 10 people worldwide—about 537 million. In most countries between 5 and 10% of the population has some form of diabetes. In Pakistan almost 1 in 3 people are affected, while in Mauritania only 1 in 50 people have the condition. Although the correlation of diabetes with growing rates of obesity and the use of highly processed foods may seem to indicate that this is a distinctly modern problem, that’s not really the case.
A description of the disease was found in an Ancient Egyptian manuscript from around 1500 BC, and the term diabetes, “to pass through”, was used by a physician in Ancient Greece to refer to excessive urination, one method the body uses to eliminate excess sugar and a common symptom of diabetes suffers. In the past, diabetes was diagnosed by tasting the urine of a patient to detect sweetness.
It was only in 1921 that the hormone insulin, now the primary treatment for type 1 diabetes, was first isolated and the first experiments were performed to understand its role in regulating blood sugar. Prior to this discovery, most sufferers remained undiagnosed, and even if their problem was identified, they often died all too soon of diabetes-related complications. Over the past century, we have learned a great deal about how to successfully manage this condition and related symptoms.
Type 1 diabetes is an autoimmune condition that leads the body to mistakenly destroy its beta cells, specialised cells in the pancreas that produce insulin.
It is typically diagnosed in infants and young children but can also begin in adulthood. Type 1 diabetes is not caused by diet or lifestyle; it is considered a genetic condition, but an environmental trigger may also be involved. Only 5–10 % of diabetes sufferers have type 1 diabetes.
To avoid serious systemic consequences, people with type 1 diabetes must closely monitor their blood sugar levels and control glucose absorption by taking insulin daily. This can be especially challenging with small children but daily insulin intake procedure gets easier with familiarity and practice. The regimen must be continued throughout one’s lifetime as there is currently no known cure.
Insulin can be administered by syringe, insulin pen (with a pre-measured dose), or insulin pump—a small device attached to the skin that delivers a frequent, low basal dose of insulin throughout the day plus an additional, high-dose bolus at mealtimes through a small catheter. Pumps come in a variety of models that have some important differences. They are generally more consistent and accurate but must be filled, programmed, and monitored, and it can take some time to learn to use one correctly.
Your doctor can help you decide on the system that best matches your needs and lifestyle. You should always have some insulin injections on hand in case the pump malfunctions.
Type 2 diabetes, also known as insulin resistance, is by far the most common form of diabetes. In people with type 2 diabetes, the pancreas produces insulin, but the cells do not respond to it as they should. The pancreas steps up insulin production, but this is not enough to allow the cells to process blood glucose and generate the energy the body the needs to function.
It is thought that insulin resistance develops slowly over time as type 2 diabetes is mostly diagnosed in adults, however children also sometimes develop the condition, especially around puberty when growth hormone levels increase in the body. Other risk factors include being overweight, having polycystic ovary syndrome, and being born to a mother with gestational diabetes.
Type 2 diabetes is usually controlled, and can sometimes be reversed, by monitoring blood sugar levels and following diet and exercise recommendations. In some cases, weight loss may be recommended as there is a corelation between excess weight and the ability to process glucose, but not all heavyset people have diabetes, and you don’t need to be overweight to develop insulin resistance.
It is important to regulate blood sugar levels to avoid serious health complications. If necessary, your doctor may prescribe a short-acting insulin for mealtimes, a long-acting insulin for between meals and overnight, or a non-insulin medication such as Metformin to help regulate your blood glucose.
Otherwise healthy women sometimes develop gestational diabetes during pregnancy; approximately 2–10 % of pregnancies are affected.
Gestational diabetes occurs when the hormonal changes that come with pregnancy also affect how the body creates, stores, and uses insulin, leading to potentially dangerous insulin resistance. Gestational diabetes usually develops around week 24 of pregnancy (often earlier in women expecting twins or multiples), but the problem generally resolves itself once the baby is born.
Women with gestational diabetes require close monitoring of blood pressure, blood sugar levels, and insulin balance throughout pregnancy, and are at higher risk of preeclampsia. If they follow the recommended treatment plan, most women with gestational diabetes make it safely though pregnancy and deliver their babies normally, however in some cases delivery by Caesarean section may be required. Both mother and child have a higher risk of developing type 2 diabetes later in life, but this risk can be managed.
While the precise cause of gestational diabetes is not fully understood, risk factors include being overweight and having a genetic predisposition to insulin resistance. If you are already pregnant, work with your doctor or gynaecologist to monitor your health. Accepting your situation and following the prescribed treatment plan are the best way to take care of your body and your baby.
The primary way of identifying diabetes is by testing blood sugar levels over time. If they remain high for an extended period, there is a good chance you are diabetic or pre-diabetic.
Acanthosis nigricans can be a tell-tale sign of type 2 diabetes. This is when velvety or rough dark streaks or patches appear on the skin, especially on the back of the neck and in folds and creases such as the armpits, inner elbows, and groin.
Both type 1 and type 2 diabetes come with a host of potential symptoms affecting the entire body, although they may go unnoticed for a long time and then seem to come on suddenly.
Sudden weight loss or loss of muscle mass can also sometimes be a sign that your body is struggling to use its resources effectively under the burden of diabetes.
If you have been diagnosed with diabetes or told that you are at risk of developing the condition, please take it seriously. If left untreated, diabetes can result in life-threatening complications including kidney disease, liver disease, nerve damage, reduced blood flow—especially to the arms and legs, problems with oral health, vision, and hearing, and cardiovascular disease with serious risk of heart attack. Your mental health can also suffer when your body is dealing with diabetes and associated problems.
Receiving a diagnosis of diabetes can be a shock but it doesn’t have to mean that life as you know it is over. You will probably need to make some lifestyle adjustments, but with proper management you can live a healthy and fulfilling life.
We all need emotional support from time to time, and diabetes can be challenging to deal with. Sharing your struggles with a trusted friend or a mental health professional can help ease the load. There are also many national and international organisations that help educate and support people suffering from diabetes. You don’t have to do it alone.
Managing diabetes is a lifelong process, and there may be some hurdles or setbacks along the way. Be patient with yourself and others as you come to terms with the diagnosis and learn to manage your body’s needs. Be sure to celebrate your successes, even the small ones, to give yourself the gift of positive reinforcement!
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